Transseptal puncture: Review of anatomy, techniques, complications and challenges, a critical view

Almendárez, Marcel; Álvarez-Velasco, Rut; Pascual, Isaac; Alperi, Alberto; Morı́s, César; Avanzas, Pablo

doi:10.1016/j.ijcard.2022.01.011

Cited by 23 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transseptal puncture carries a low, albeit real, risk of cardiac perforation posteriorly to the LA or anteriorly to the ascending aorta. 14 , 15 The incidence of cardiac perforation during TSP is ∼1%. 16 , 17 Inadvertent puncturing of adjacent structures may occur because of the misdirected setting of the orientation of the needle or the sliding of the needle at the time of TSP.…”

Section: Discussionmentioning

confidence: 99%

Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial

Hu,

Xu,

Qiao

et al. 2023

Europace

View full text Add to dashboard Cite

Aims This study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique vs. the conventional approach in facilitating access into the left atrium during left atrial appendage occlusion (LAAO) procedures for the treatment of atrial fibrillation. Methods and results The ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicentre, randomized controlled trial (NCT05125159). Patients with atrial fibrillation who underwent LAAO were prospectively enrolled from four centres and randomly assigned to an angioplasty guidewire-assisted TSP group (n = 131) or to a conventional Brockenbrough needle TSP group (n = 132). The primary endpoint was the one-time success rate of TSP. We also analysed the TSP procedure time, failure rate of the assigned TSP type, radiation dose, contrast dose, and procedural complications in both groups. All patients in the guidewire-assisted group underwent successful TSP, whereas five in the standard conventional group switched to the guidewire-assisted approach. The guidewire-assisted puncture improved the one-time success rate (92.4 vs. 77.3%, P = 0.001), shortened the TSP procedure time (109.2 ± 48.2 vs. 120.5 ± 57.6 s, P = 0.023), and tended to have a higher rate of good coaxial orientation of the sheath with the left atrial appendage during the LAAO procedure (66.4 vs. 54.5%, P = 0.059). No TSP-related complications occurred in the guidewire-assisted TSP group, whereas two complications occurred in the conventional TSP group. There was no significant difference in the failure rate of the assigned TSP type, the total procedure time, the total radiation dose, the rate of successful LAAO implantation, or the procedural complication rate between the two groups (all P > 0.05). Conclusion This study confirmed that angioplasty guidewire-assisted puncture can effectively improve the success rate of TSP during LAAO procedures. This novel technique has high potential for application in interventional therapies requiring TSP.

show abstract

Section: Discussionmentioning

confidence: 99%

Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial

Hu,

Xu,

Qiao

et al. 2023

Europace

View full text Add to dashboard Cite

show abstract

“…The latter should be taken into account when individualizing AF ablation approach, since in the presence of an ASD, the RA is likely implicated in AF initiation and maintenance and thus should be evaluated as potential ablation target. 158 , 167 …”

Section: Anatomical Considerations—implications For Catheter Ablationmentioning

confidence: 99%

“…Available technologies that facilitate crossing of the septum in challenging anatomies are presented in Section 7.5 . 157 , 158 , 161 , 167 , 168 Anatomic variations of interatrial septum and clinical settings that may be encountered during transseptal puncture are presented in Figure 4 .…”

Section: Anatomical Considerations—implications For Catheter Ablationmentioning

confidence: 99%

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Tzeis,

Gerstenfeld,

Kalman

et al. 2024

Europace

View full text Add to dashboard Cite

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .

show abstract

“…It involves puncturing a small region within the interatrial septum (IAS) known as the fossa ovalis [1]. TSP is a technically demanding procedural step in left atrial ablation, with challenges brought about by complex anatomical atrial septum abnormalities, particularly during repeat transseptal catheterization [2]. It is associated with a steep learning curve -even for skilled operators -with a 1-2% incidence rate of major complications [3], in addition to a 2-3% incidence of cardiac perforation, pericardial effusion or tamponade, aortic root puncture, and atrial wall puncture for less skilled operators [4]. )…”

Section: Introductionmentioning

confidence: 99%

Design and Development of a Novel Force-Sensing Robotic System for the Transseptal Puncture in Left Atrial Catheter Ablation

Zeidan,

Xu,

Mower

et al. 2023

2023 IEEE International Conference on Robotics and Automation (ICRA)

View full text Add to dashboard Cite

show abstract

Transseptal puncture: Review of anatomy, techniques, complications and challenges, a critical view

Cited by 23 publications

References 31 publications

Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial

Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled trial

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Design and Development of a Novel Force-Sensing Robotic System for the Transseptal Puncture in Left Atrial Catheter Ablation

Contact Info

Product

Resources

About